Robotic spine fusion bridges the surgeon learning gap: A 5-year analysis of screw placement accuracy and efficiency between experienced and inexperienced surgeons

Pedicle screw placement has evolved from freehand to fluoroscopic guidance to navigation-assisted techniques. While robotic-assisted spine surgery offers enhanced accuracy and pre-operative planning capabilities, its adoption has been limited by concerns regarding operative efficiency and surgeon experience requirements. Modern robotic platforms may help standardize screw placement across varying levels of surgical experience. A retrospective review of prospective robotic spine fusion cases (2019-2024) compared experienced (n=2) and inexperienced (n=4) neurosurgeons performing lumbar fusions. Data included screw-to-screw placement times, accuracy (Gertzbein and Robbins system), and revision rates. Statistical analysis used Welch's t-test with p<0.05 considered significant. Analysis included 39 patients (179 pedicle screws). Inexperienced surgeons showed rapid improvement within their first 10 screws. No significant difference in average screw times between inexperienced (mean 3.3 mins, SD 4.34) and experienced surgeons (mean 2.27 mins, SD 1.71), p=0.238. Overall screw accuracy was 96.6% (173/179). Four screws (2.2%) had lateral misplacement due to facet arthropathy, all by experienced surgeons. One screw had minimal medial pedicle breach, and two (1%) were aborted. Modern robotic spine surgery platforms standardize screw placement times across experience levels and accelerate learning. Inexperienced surgeons can reach proficiency comparable to experienced surgeons after fewer cases, effectively bridging the learning gap and enhancing surgical efficiency.